Gender Differences in Survival in an HIV/AIDS Cohort from São Paulo, Brazil

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Abstract
Highly active antiretroviral therapy accounted for significant improvement in AIDS prognosis. However, in areas where access to antiretrovirals is universal, the impact of treatment might have been less remarkable among women. To compare survival between men and women living with HIV, we studied a retrospective cohort of 1072 patients who attended a Brazilian reference center. Time to AIDS-related death was the dependent variable. Medical charts were reviewed to obtain sociodemographic data, clinical, and laboratory outcomes. Cumulative survival probability was estimated by the Kaplan-Meier method and hazard ratios by Cox proportional hazards model. At admission, 55% of men and 38% of women had AIDS. Ninety-one AIDS-related deaths occurred in 6004 person-years of follow-up (PYFU). After adjustment for antiretroviral therapy, predictors of death included: female gender (p = 0.02), age at HIV diagnosis (p = 0.005), lowest CD4 count less than 200 cells/mm3 (p < 0.001) and highest viral load greater than 100,000 copies per milliliter during follow-up (p = 0.007), having an AIDS-defining illness before admission or during follow-up (p < 0.001). We provide evidence that women have benefited less from care, though admitted to the clinic at earlier stages of HIV disease and offered standardised therapeutic interventions. However, the reasons for such gender differences in survival still remain unclear. Further studies are thus warranted to help recognize factors associated to a higher vulnerability in care among women, what may help establish strategies to enhance care for all people living with HIV and for women, in particular.